National
What’s next for health care reform?
After court ruling, focus turns to state plans for Medicaid
Now that the Supreme Court has upheld the constitutionality of President Obama’s health care reform law, advocates are pushing for additional efforts to extend coverage of the law to LGBT people and people with HIV/AIDS to the fullest extent possible.
For the most part, the next step in the process involves looking to the states to determine whether they will adopt health policies afforded to them under the law — foremost among them is the Medicaid expansion to cover all people with incomes up to 133 percent of the federal poverty level.
Although the Supreme Court ruled the majority of the health care law is constitutional, it prevented the federal government from withholding all Medicaid funds from states if they decline to take part in the Medicaid expansion. As a result, states can decide whether or not to enter the expansion without fear of losing money.
Patrick Paschall, a policy advocate at the National Gay & Lesbian Task Force, said the Medicaid expansion is particularly important for LGBT people because they disproportionately live below the poverty level.
“The Medicaid expansions are going to end up being hugely important for LGBT people because it expands coverage to low-income people, and LGBT people are disproportionately low-income,” Paschall said. “We know this because of rampant employment discrimination and housing discrimination.”
A report on transgender people published earlier this year by the Task Force and the National Center for Transgender Equality, titled “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey,” found that transgender people experience unemployment at rates twice that of the national population, and black transgender people experience it at a rate of four times as much.
Carl Schmid, deputy executive director of the AIDS Institute, said the Medicaid expansion is particularly important for people with HIV/AIDS because of 50 percent of those in care rely on that program for support and those numbers will “grow substantially” if states decide to participate.
“Those who are really poor, they’re going to be covered under Medicaid,” Schmid said. “The question is what are we expecting from the states.”
But a number of states may not take part. According to a report in The Hill newspaper, at least 15 governors have signaled they won’t participate in the Medicaid expansion now that the Supreme Court has enabled them to wiggle out of participation.
Florida Gov. Rick Scott, a Republican elected to office during the Tea Party wave in 2010, was among those saying his state wouldn’t take part in the Medicaid expansion — or other parts of the health care law that are optional to the states.
“We’re not going to implement Obamacare in Florida,” Scott said last week on Fox News. “We’re not going to expand Medicaid because we’re going to do the right thing. We’re not going to do the exchange.”
Under the health care reform law, the federal government will pay for the Medicaid expansion for the first few years. Expenses for states come up in 2017, when the federal government will pay 95 percent; That’s reduced to 94 percent in 2018 and in 2019 it goes down to 93 percent. Starting in 2010 and then on out, the federal government will pay 90 percent of the total amount.
Schmid said the bargain that was set up for states under the health care law makes the governors’ decision not to participate in the law questionable.
“Here their taxpayers are going to be paying their taxes to pay for this; this is federal funds,” Schmid said. “Their state is not going to take responsibility for covering. The hospitals? Don’t they want people to be covered? They’re going to have unconstituted care if they don’t.”
For the states that don’t participate in the Medicaid expansion, Schmid said people living there with HIV/AIDS will have to continue relying on the Ryan White Care Program, which provides funds for AIDS medications for low-income people with HIV. The program will be up for reauthorization in 2013.
As advocates push for states to adopt the Medicaid expansion, the law has several key components that already offer protections and benefits for LGBT people and people with HIV/AIDS. State and federal health insurance will be set up in the law starting in 2014.
For the first time, the law extends federal non-discrimination protection in the health care system on the basis of gender.
Paschall noted that provision is key as courts and agencies have determined that discrimination against transgender people amounts to gender discrimination.
“We know that federal agencies like the Equal Employment Opportunity Commission, the Department of Housing & Urban Development as well as federal courts have interpreted sex-based discrimination to include protections on the basis of gender identity and sex stereotypes,” Paschall said. “What this means is that in the context of health care, LGBT people, especially transgender people have now for the first time protections in that setting, which is hugely important.”
Earlier this year, the Department of Health & Human Services issued rules saying that no program activity in an exchange, nor a health plan, can discriminate on the basis of sexual orientation and gender identity. The rule takes effect when exchanges open in 2014.
The administration has taken additional efforts to help the LGBT community when it comes to accessing health care. Same-sex couples can now search for health plans that cover domestic partners through the health care finder tool at healthfinder.gov. HHS has also undertaken data collection efforts to include questions about sexual orientation and gender identity in surveys like the National Health Interview Survey.
Still, advocates are looking for additional efforts from the administration — in addition to the adoption of the Medicaid expansion by the states — to ensure LGBT people are included in health care reform to the greatest extent possible.
Paschall said the Task Force wants to see data collection efforts expanded beyond the federal surveys already designated by the administration.
“Generally speaking, we would like to see sexual orientation and gender identity questions added to all federal surveys where demographic data is collected,” he said. “Our priorities include a number of federal surveys, maybe most notably the American Community Survey, which is an annual survey that collects demographic data and is considered one of the largest annual data sources on the American population.”
For people living with HIV/AIDS, Schmid said he is awaiting from the administration regulatory guidance in the next couple months on essential health benefits to cover people in the Medicaid program and federal exchanges.
“We’ll see if the coverage will be strong enough for medications and for all different other services,” Schmid said.
Tennessee
Charlie Kirk Act advances in Tenn.
Bill would limit protests, protects speakers opposing ‘transgender’ identities
The Tennessee legislature has passed Senate Bill 1741 / House Bill 1476, dubbed the “Charlie Kirk Act,” which, if signed by Republican Gov. Bill Lee, would reshape how public colleges and universities regulate speech on campus.
The measure targets all public higher education institutions and requires them to adopt a “free expression” policy modeled on the University of Chicago’s framework. That framework emphasizes that universities should not shield students from controversial or offensive ideas and requires state schools to formally embrace institutional neutrality — meaning they do not publicly take a stance on political or social issues.
Under the legislation, publicly funded schools cannot disinvite or cancel invited speakers based on their viewpoints or in response to protests from students or faculty. Student organizations, however — like Turning Point USA, an American nonprofit that advocates for conservative politics on high school, college, and university campuses, founded by Charlie Kirk, and often lack widely represented liberal counterparts — would retain broad authority to bring speakers to campus regardless of controversy.
The law includes broad protections for individuals and organizations expressing religious or ideological beliefs, including opposition to abortion, homosexuality, or transgender identity, regardless of whether those views are rooted in religious or secular beliefs. It further prohibits public institutions from retaliating against faculty for protected speech or scholarly work.
The bill, which has been hailed by supporters as an effort to “preserve campus free speech,” ironically also limits protest activity. Shouting down speakers, blocking sightlines, staging disruptive walkouts, or physically preventing entry to events are now considered “substantial interference” under the legislation, making those who engage in such actions subject to discipline.
Some of those disciplinary consequences include probation, suspension, and even expulsion for students, while faculty who protest in ways deemed to violate the policy could face unpaid suspensions and termination after repeated violations.
Supporters of the bill argue it strengthens free expression on campus. State Rep. Gino Bulso (R-Brentwood), the bill’s sponsor, said it reinforces a commitment to “civil and robust” debate at public universities.
“The Charlie Kirk Act creates critical safeguards for students and faculty and renews the idea that our higher education institutions should be centers of intellectual debate,” Bulso told Fox 17. “This legislation honors the legacy of Charlie Kirk by promoting thoughtful engagement and defending religious freedom.”
Critics, including Democratic lawmakers, have raised concerns that the legislation effectively elevates certain ideological viewpoints — particularly those tied to religious objections to LGBTQ identities — while exposing students and faculty to punishment for protest or dissent.
“It’s ironic that this body is talking about free speech when we had professors in Tennessee schools expelled and suspended when they did not mourn the death of Charlie Kirk — when they said that his statements were problematic and that the way he died did not redeem the way he lived,” state Rep. Justin Jones (D-Nashville) told WKRN.
Kirk, the right-wing activist and founder of Turning Point USA, for whom the bill is named, was assassinated in September 2025 at a public event at Utah Valley University. His legacy and rhetoric remain deeply polarizing, particularly among LGBTQ advocates, who have cited his history of anti-LGBTQ statements in opposing his campus appearances.
The bill now heads to Lee’s desk for his signature.
National
Demonstrators disrupt OMB director hearing over PEPFAR
Capitol Police arrested five protesters
A group of protesters interrupted Office of Management and Budget Director Russell Vought during his testimony before Congress on Wednesday.
Vought was at the Cannon House Office Building to give testimony to the House Budget Committee.
Committee Chair Jodey Arrington (R-Texas) began the hearing by touting what he described as economic accomplishments of the Trump-Vance administration’s economic accomplishments. Ranking Member Brendan Boyle (D-Pa.) disputed those claims in his opening statement.
Boyle went on to admonish Vought for not attending a committee hearing in the previous year.
Vought, the “Project 2025” architect, was invited to speak after Arrington and Boyle made their statements.
Shortly after Vought began reading his statement, Housing Works CEO Charles King stood up in the gallery and began shouting, “PEPFAR saves lives: spend the money!”
The U.S. Capitol Police moved quickly to escort King from the room. Other activists began chanting with King as they unfolded signs bearing a picture of Vought’s face and statements such as, “Vought’s cuts kill people with AIDS,” and “Protect PEPFAR from Vought.”
The group of HIV/AIDS activists included independent activists, former U.S. Agency for International Development and PEPFAR staff, members of Health GAP, Housing Works, and the Treatment Action Group. Six activists were escorted from the hearing and the U.S. Capitol Police detained five of them.
The HIV/AIDS treatment activists protested at the hearing in response to the dismantling of global health programs, including PEPFAR, a federally-funded program credited with saving millions of lives from HIV/AIDS, particularly in sub-Saharan Africa.
“Russell Vought is directly responsible for illegally withholding Congressionally appropriated funds for PEPFAR and related global health initiative,” King said in a statement provided to the Washington Blade. “These funding disruptions have already contributed to preventable deaths and threaten to reverse decades of progress in the fight against HIV worldwide. Enough is enough. Congress must ensure Vought stops this deadly sabotage.”
National
HIV/AIDS group NMAC is ‘destabilized’ and in financial crisis: sources
Organization disputes allegations of mismanagement by new CEO
A statement sent to the Washington Blade by an anonymous source claiming to be a current staff member at NMAC, formerly known as the National Minority AIDS Council, alleges that the prominent HIV/AIDS advocacy organization is facing “a rapid and systemic collapse of leadership, governance, and ethical standards.”
The three-page detailed statement sent on April 4 by someone identifying himself only as “John Doe” includes multiple specific allegations that NMAC CEO Harold Phillips, who began his position in October 2025, “has destabilized the organization at every level,” including hiring nine new high-level appointees with salaries of $220,000 each who are performing “duplicative and unjustifiable roles.”
The Blade was able to corroborate some of the allegations by talking to two other knowledgable sources who spoke on condition of anonymity. Those sources said they had received the John Doe statement and believed many, if not most, of its allegations were accurate.
With a total staff of about 30 to 35 employees, the John Doe statement claims the high salaries of the nine new staff members have added to financial problems NMAC has been facing in recent years. It says that at least two NMAC staffers who raised concerns about Phillips’s actions were terminated on grounds of insubordination.
One of the two anonymous sources who spoke to the Blade said one of the dismissed staff members was considering filing a lawsuit against NMAC in response to the firing.
“An external firm was recently brought in to assess the organizational health,” the John Doe statement to the Blade says. “The findings were staggering — more than 50% of staff reported they are actively seeking employment elsewhere,” it says.
The Blade sent the John Doe statement to NMAC this week and asked for a response to the allegations.
NMAC spokesperson Jennifer Moore Phillips, who serves as chief strategy officer and who is not related to Harold Phillips, sent the Blade a short statement calling the John Doe allegations “false and purposefully misleading,” but which did not comment on each of the specific allegations.
“A recent anonymous letter containing unfounded allegations about NMAC makes claims that are simply false and purposefully misleading,” the NMAC statement says. “Evidenced by our new strategic plan and recent successful Biomedical HIV Prevention Summit in Chicago, NMAC’s new leadership is laser focused on delivering on our mission serving the HIV community with renewed energy and vision,” the statement concludes.
The Biomedical HIV Prevention Summit referred to in the statement, which took place in Chicago April 8-10 of this year, is one of the two largest HIV/AIDS related conferences that NMAC organizes each year. Jennifer Phillips said more than 1,400 people attended the event.
The largest NMAC event, the United States Conference on HIV/AIDS, the most recent of which was held in D.C. Sept. 4-7, drew more than 2,400 participants and was hailed by AIDS activists as a highly successful gathering of a diverse group of experts seeking to push for the end to the HIV/AIDS epidemic.
One of the keynote speakers at that conference was Paul Kawata, who served as executive director and CEO of NMAC for 36 years and who delivered his farewell address at the conference following the announcement that he would retire on Oct. 7, 2025.
Many of the conference speakers praised Kawata, who became NMAC’s leader two years after its founding in 1987, as the leading force behind its growth and evolution into one of the nation’s leading HIV/AIDS advocacy organizations with a special outreach to people of color.
It was at that time that Harold Phillips, who served as director of the White House Office of AIDS Policy under then-President Joe Biden and who later joined NMAC as deputy director before the NMAC board named him Kawata’s successor as CEO, emerged as NMAC’s next leader.
“The Board has exuberantly elected Harold Phillips as our new CEO,” said Lance Toma, chair of the NMAC Board of Directors at the time Phillips’s appointment was announced. “In this unprecedented moment, there is no one more strategically positioned and experienced to lead our movement through what we know will be some of the most tumultuous and complicated times ahead,” the statement said.
The John Doe statement raising questions about Phillips’s actions and leadership says NMAC staff members formally appealed to the board of directors to intervene.
“The Board has remained silent, while Harold arrogantly told the staff that ‘the board has my back,’” the statement says.
The Blade has also attempted to reach out to Kawata by email for comment on how he feels NMAC is doing six months after his retirement. As of April 14, Kawata had not responded to the Blade’s inquiry.
According to the John Doe statement, NMAC officials have recently “sought external financial rescue,” including a visit by an NMAC official to California to request assistance from the pharmaceutical company Gilead Sciences. “Without such intervention, layoffs seem imminent,” the statement says.
“This is not a functioning nonprofit,” the John Doe statement concludes. “It is an organization in crisis – bleeding resources, hemorrhaging staff, and operating without transparency, accountability, or governance,” it says, adding, “The communities NMAC serves, the donors who fund its mission, and the public at large deserve to know what is happening behind closed doors.”
By contrast, the NMAC website describes the organization as a highly functioning nonprofit continuing to lead the fight against HIV/AIDS.
“Launched in 1987 during the early years of the HIV/AIDS crisis in the United States, NMAC is a national HIV organization that offers capacity building, leadership development, policy education, and public engagement to end the HIV epidemic among communities most impacted in the United States,” a statement on the NMAC website says.
“In 2026, we mark 45 years of the HIV movement,” the statement adds. “NMAC continues to pivot to center the needs of people of color impacted by HIV by responding to political challenges that threaten federal funding and programs that have provided an essential survival safety net,” it says. “Simultaneously, as HIV treatment allows people to age with HIV, our whole-person approach extends to achieving optimal quality of life beyond attaining viral suppression.”
In its most recent action, NMAC issued a detailed press release on April 14 criticizing President Donald Trump’s proposed fiscal year 2027 budget provisions that call for cutting more than $1.5 billion in HIV prevention, substance use, housing and other programs. The release provides details on how the cuts would negatively impact important HIV prevention programs and urges Congress to reject the proposed cuts.
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